Provider Demographics
NPI:1811583065
Name:WORTMAN, RUTH EVELYNN (REG COUNSELOR CCAPP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:EVELYNN
Last Name:WORTMAN
Suffix:
Gender:F
Credentials:REG COUNSELOR CCAPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6310
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-6310
Mailing Address - Country:US
Mailing Address - Phone:707-443-4237
Mailing Address - Fax:707-442-1191
Practice Address - Street 1:1219 10TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-2024
Practice Address - Country:US
Practice Address - Phone:707-443-0514
Practice Address - Fax:707-442-1191
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1409001120101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR1409001120OtherCCAPP